Nitrates contraindications

STE ACS class lla recommendation and NSTE ACS class I recommendation for patients with ongoing ischemia who are already taking adequate doses of nitrates and P-blockers or in patients with contraindications to or intolerance to P-blockers (diltiazem or verapamil for STE ACS and diltiazem, verapamil, or amlodipine for NSTE ACS). 

As described in the previous section, calcium channel blockers should not be administered to most patients with ACS. Their role is a second-line treatment for patients with certain contraindications to P-blockers and those with continued ischemia despite P-blocker and nitrate therapy. Administration of either amlodipine, diltiazem, or verapamil is preferred.2 Agent selection is based on heart rate and left ventricular dysfunction (diltiazem and verapamil are contraindicated in patients with bradycardia, heart block, or systolic heart failure). Dosing and contraindications are described in Table 5-2. 

Substances that have been used as preservatives for disperse systems include chlorocresol, chlorobutanol, benzoates, phenylmercuric nitrate, parabens, and others [76,77]. The use of cationic antimicrobial agents such as quaternary ammonium compounds (e.g., benzalkonium chloride) is contraindicated in many cases because they may be inactivated by other formulation components and/or they may alter the charge of the dispersed phase. Clay suspensions and gels should be adequately preserved with nonionic antimicrobial preservatives. The use of preservatives is generally limited to products that are not intended for parenteral use. Intravenous injectable... 

The most significant adverse effects of nitrates are tachycardia, flushing, headache, and hypotension. Nitrates are contraindicated in patients who... 

Calcium antagonists or long-acting nitrates for reduction of symptoms when (3-blockers are contraindicated... 

Phosphodiesterase inhibitors are contraindicated in patients taking nitrates. Phosphodiesterase inhibitors should not be administered within 4 hours of an a-adrenergic antagonist. 

Concomitant use of nitrates in any form and alpha-adrenergic blockers (other than 0.4 mg once-daily tamsulosin) is contraindicated. 

Isosorbide Dinitrate Hydralazine (BiDil) [Antianginal, Antihypertensive/Vasodilator, Nitrate] Uses HF in African Amer-icans improve survival functional status, prolong time between hospitalizations Action Relaxes vascular smooth muscle peripheral vasodilator Dose Initially 1 tab tid PO (if not tol ated reduce to 1/2 tab tid), titrate >3-5 d as tolerated Max 2 tabs tid Caution [C, /-] recent MI, syncope, hypovolemia, hypotension, hep impair Contra For children, concomitant use w/ PDE5 inhibitors (sildenafil) Disp Tabs SE HA, dizziness, orthostatic hypotension, sinusitis, GI distress, tach, paresthesia, amblyopia Interactions t Risk of severe hypotension W/ antihypertensives, ASA, CCBs, MAOIs, phenothiazides, sildenafil, tadalafil, vardenafil, EtOH X pressor response Wf i -1- effects W7 NSAIDs EMS Use ASA, antihypertensives and CCBs w/ caution, may t hypotension concurrent Viagra-type drug use can lead to profound hypotension concurrent EtOH use can t effects OD May cause N/V, profound hypotension, skin flushing, HA from ICP, bradycardia, confusion, and circulatory collapse activated charcoal may be effective, epi use is contraindicated... 

Nitroglycerin will be effective for on-going chest pain relief. Ca channel antagonists and long-acting Nitrates can be used when jS-blockers are contraindicated. These drugs may be also used for the initial therapy, additional to -blockers or when jS-blockers treatment failed. However, for the effectiveness of vasodilatation itself is relatively weaker evidence. 

Black cohosh may cause nausea, vomiting, hypotension, and even miscarriage. It is absolutely contraindicated in pregnancy. Red clover contains coumarins and should therefore be avoided with anticoagulants. Diets high in red clover isoflavones have reduced livestock fertility and theoretically could do the same in humans. Flaxseed may cause nausea, diarrhea, and flatulence. Cyanogenic nitrates in flax (especially in immature seed pods) have produced toxic reactions. 

Contraindications Closed-angle glaucoma, severe anemia, head injury, postural hypotension, hypersensitivity to nitrates... 

Contraindications Closed-angle glaucoma, GI hypermotility or malabsorption (extended-release tablets), head trauma, hypersensitivity to nitrates, increased intracranial pressure, orthostatic hypotension, severe anemia (extended-release tablets)... 

Contraindications Allergy to adhesives (transdermal), closed-angle glaucoma, constrictive pericarditis (IV), early MI (sublingual), GI hypermotility or malabsorption (extended-release), head trauma, hypotension (IV), inadequate cerebral circulation (IV), increased intracranial pressure (ICP), nitrates, orthostatic hypotension, pericardial tamponade (IV), severe anemia, uncorrected hypovolemia (IV)... 

Contraindications Concurrent use of sodium nitroprusside or nitrates in any form... 

Contraindications Concurrent use of alpha-adrenergic blockers (other than the minimum dose tamsulosin), concurrent use of sodium nitroprusside or nitrates in any form, severe hepatic impairment... 

The major acute toxicities of organic nitrates are direct extensions of therapeutic vasodilation orthostatic hypotension, tachycardia, and throbbing headache. Glaucoma, once thought to be a contraindication, does not worsen, and nitrates can be used safely in the presence of increased intraocular pressure. Nitrates are contraindicated, however, if intracranial pressure is elevated. 

Left ventricular pressure measurements are monitored continuously by use of a 5F end-hole pig-tail catheter in the left ventricular apex and a 6F femoral sheath in order to be able to assess the gradient, If the outflow gradient is absent or small under the basal conditions, the magnitude of provocable obstruction is most appropriately assessed with maneuvers (Valsalva, ventricular pacing, extrasystoles, physiological exercise, amyl nitrate), The inability to elicit any provocable gradient is a contraindication to the procedure,... 

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